Management test 3
Common contributing issues for injury accidents
- not working within scope of practice - not working under/providing supervision for clients/peers - not effectively communication with client/medical team - failing to provide a safe environment - operating outside of organizational policies/procedures
Administrative directives examples
- pressure to provide intervention beyond practitioner's competency - unrealistic productivity demands - violations of the OT scope of practice - inability to d/c patients when goals are met - inadequate supervision - use of unqualified personnel to provide skilled service
Sstatutory law is created by
Congress (federal level)
EEOC
Enforces federal laws by investigating employee complaints, conducting investigations, and filing lawsuits on behalf of the employee
Debarred
OTs can be debarred from participation in healthcare programs as a consequence for fraud
Occupational therapy services
The skilled actions provided by an occupational therapy practitioner
Skilled services
Those services requiring the skills of physical therapists, speech language pathologists, or occupational therapists
OSHA recordable events
Work related injuries and illnesses that require more than simple first-aid management
An ethical workplace -
empowers employees
Client-centered care
issues with high productivity and point of service documentation limits client-centered practice however, role modeling and reflection can promote professional conducts that instills the need for ethical behaviors and standards
Key elements of job descriptions
job title, job function, reporting relationships, key performance expectations, qualifications, and essential functions
Vizient
largest member-driven group in the US for performance improvement
Measuring outcomes that matter most to patients has 4 benefits:
learn improve performance superior outcomes value-based payment
Regulations impose
legal obligations for practitioners and public response (ADA)
Salaries
many clinicians are paid a yearly salary versus hourly rate
Purpose is often referred to as the:
mission statement
PHI
protected health information
3 measures for determining the quality of health care
structural measures process measures outcomes measures
Co-insurance
% of a service that beneficiaries must pay per visit after their deductible is met
Examples of torts
- battery and assault - false imprisonment - intentional infliction of emotional distress - negligence - malpractice
Ethical culture can be promoted by:
- continuing education - awareness - promotion of available resources - application of framework for decision making
Contracts should state:
- definition of relationship - duties or responsibilities of contractor - services to be performed - specific licensure, certifications, or other qualifications - billing timelines - notice of termination or modification of contract
Why is quality measurement important?
- determine whether OT is meeting client needs - determines effectiveness of services - peers are moving toward quality-focused reimbursement measures, meaning will pay more for services that are efficient and effective
Practical issues that guide clinical implementation:
- ease of access (time to retrieve instruments) - test burden degrades instrument utility (patient endurance, staffing, etc)
Examples of malpractice in OT
- improperly transferring a client resulting in a fall - forgetting to tell nurse of client's complaints of chest pain, resulting in heart attack - improperly maneuvering a w/c resulting in a fall or accident - failure to secure sharp objects
Strategies to combat moral distress:
- managers should work with staff to identify alternative approaches to enable clients to achieve goals when OT sessions may be limited - discourage unethical conduct - start by ensuring OTs are working within state licensure
The challenges of measuring outcomes
- new outcomes are narrowly focused - practitioners "tweaking" existing measures - unnecessary creation of new instruments
How can entrepreneurs reduce risk?
- start a business part time while having traditional job - form a partnership with someone with business knowledge - having in-depth knowledge of characteristics of an entrepreneur
Strategic goals
- typically measurable over a 3-5 year period - typically 5 or less goals
Coding is used to....
-Describe the diagnoses of clients served -Identify the complexity of the occupational therapy evaluation -Describe the type and amount of intervention provided
Two levels of Healthcare Common Procedure Coding Set (HCPCS codes) used by CMS
-Level 1 codes: 5-digit AMA CPT codes -Level 2 codes: owned by CMS and can be recognized by their alpha-numeric format
Reimbursement payment process involves...
-Provision of OT services -Documentation of services -Coding of services -Billing of claims -Reimbursment for services
Three organizations that provide essential information for coding:
-World Health Organization (WHO) -American Medical Association (AMA) -Centers for Medicare and Medicaid Services (CMS)
Medicare fraud includes...
-knowingly submitting, or causing to be submitted, false claims or making misrepresentations of fact to obtain a federal health care payment for which no entitlement would otherwise exist -knowingly soliciting, receiving, offering, and/or paying remuneration to induce or reward referrals for items or services reimbursed by federal health care programs -making prohibited referrals for certain designated health services
Negligence must be proved in 4 elements:
1) duty to act in a particular way 2) a breach of that duty 3) actual harm or damage 4) casual connection between the breach of duty and the harm or damages
2 types of professional liability policies
1) occurrence-based 2) claims made
Two approaches to conduct a market analysis:
1) organizational assessment (self assessment) 2) environmental assessment (trends)
Job function
1-2 sentences that capture the main purpose of the job
The IRS considers 3 aspects of control when defining contractor eligibility:
1. behavioral control 2. financial control 3. the parties' relationship
Two types of W-2 employees
1. exempt from overtime 2. nonexempt from overtime
Outcome measures must meet these 5 specific objectives:
1. identification of specific outcomes to be measured 2. selection of assessment tools and outcome measures are standardized, reliable, and valid 3. use of measurement approaches that reduce confounding factors - standardized procedures 4. enhanced data collection, interpretation, and analysis 5. effective dissemination of results to meet objectives
4 steps in market management
1. market analysis 2. planning 3. implementation 4. monitoring
4 steps to implementation of program
1. needs assessment 2. program planning 3. program implementation 4. program evaluation
Fiscal year
12 month period that is not always Jan - Dec; this is how a budget is typically submitted
How many identifiers are there in PHI?
18
Contractors pay ____ types of taxes ___ times per year
3 types, 4 times per year 1. federal income tax 2. federal self-employment tax 3. state and local income tax
National average of units billed in PT/OT
3.5 units per patient
Marketing trends
3/4 of patients use search engines before making appointments
How much is recommended for contractors to put aside for taxes?
30%
How long should a therapist provide direct, one-on-one therapy for to receive reimbursement for a time based treatment code?
8 minutes
Strategic planning
A process used by organizations to chart or map future plans and goals
State-run workers' compensation programs
Administered by a state agency, commission, or board following general regulations set forth by the individual state's legislative body
Employment laws cover which areas of employment?
All - hiring, performance reviews, compensation, workplace wellness programs, employee benefits, and termination
False claims act
Also called the "lincoln law" or "whistleblower law", imposes liability on anyone who knowingly submits a false claim to the federal government
14th Amendment
Amendment of the US constitution prohibits discrimination based on national origin, race, or gender
Who publishes CPT codes every year and updates the codes used for submitting claims?
American Medical Association (AMA)
Maximum medical improvement (MMI)
An individual has exhausted all reasonable medical interventions to improve his or her condition and recovery has reached a plateau
Billing agents
Are aware of the rules and language set by specific providers related to submitting electronic claims and understanding the explanation of benefits that are returned to providers
Civil monetary penalties law (CMP)
Authorizes the imposition of substantial civil money penalties or very large fines against entities that engage in certain prohibited activities
How is permanent partial disability calculated?
Calculated based on a count of body parts or the percentage of the body affected or impaired by the injury or calculated the same way as other types of disability, that is, based on severity of the resulting disability due to impairments in functional performance.
OSHA is enforced by the.....
Department of Labor (DOL)
The Federal Occupational Safety and Health Act (OSHA)
Designed to prevent injury and disease among workers
Return-to-work hierarchy
Establishes a preferential structure of return-to-work goals based on the highest probability of success due to the least amount of challenges or barriers
Independent medical examination
Examination conducted by a physician or health care provider who has not been previously involved in the determination or management of the claim for a second opinion on the severity of the injury or impairments, recovery prognosis, or disability status.
Threats in a SWOT analysis
External actions or events - current or potential- that may cause harm to the organization's strategic growth, well-being, and possible competitiveness
Opportunities in a SWOT analysis
External events or possible or current changes in the environment that may affect the organization in a potential positive capacity
Title VII of the Civil Rights Act
Federal law that prohibits discriminating against employees on the basis of sex, race, color, national origin, and religion
Reimbursement
Financial remuneration for services provided.
What defines and sets limits on disclosure of PHI?
HIPPA
L-codes
Identify specific types of orthotics provided to beneficiaries by durable medical equipment companies
Fair Labor Standards Act
Imposes minimum wage and overtime standards on most employers
Direct medical expenses
Include hospitalization and physician visits, diagnostic tests and surgical procedures, outpatient procedures and rehabilitative interventions, and drug and prescription costs.
False claim
Includes knowingly making a false or fraudulent claim for payment or causing others to and knowingly using or causing others to use false records or statements, such as false progress notes or false bills
Remuneration
Includes the transfer of anything of value, directly or indirectly, overtly or covertly, in cash or in kind.
Sexual harassment
Includes unwelcome sexual advances, requests for sexual favors, and verbal or physical harassment of sexual nature
Strengths in a SWOT analysis
Internal assets or characteristics within the organization or unit that enhance the organizations capacity for growth or change
Weaknesses in SWOT analysis
Internal conditions or characteristics within the organization or unit that hinder or restrict the organization's growth potential
Stakeholder input
Key information or data collected from individuals, agencies, organizational units, and consumers who are invested in the success of the organization and its mission
Most widely used Level 2 HCPCS codes
L-codes and G-codes
Doctrine of respondent superior
Latin for "let the master answer" from the historical master-servant relationship
Key performance expectations
List format that lists frequent and important job tasks that a person much perform in order to meet the clinic's expectations
Fraud
Making false statements or representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist
Work related injuries and illnesses
Medical conditions directly resulting from activities, incidents, or exposures related to the workplace and occurring during the course of employment
Strategy
Methods or activities that enable achievement of the plan's goals
Current Procedural Terminology (CPT) codes
Numerical codes assigned to each intervention, treatment, or procedure and is sometimes referred to as a "procedure code"
Liability
OT practitioners, managers, or administrators must realize the possibility of complaints or accusations of improper conduct, inappropriate treatment, or ethical violations because complaints can be brought to employers, state boards, NBCOT, AOTA, or even civil court
Professional responsibility
OTs are responsible for all aspects of OT service delivery and are accountable for the safety and effectiveness of services
Disclosure exfeptions
OTs have a legal obligation to report suspected child abuse, elder abuse, credible threats to potential victims by persons being treatment by mental health professionals, and impaired drivers based on OT assessment
Lost-time claims
Occurs when an injury or illness prohibits an employee from continuing to carry out the essential functions of a job in a safe or effective manner
Failure rate
Of all US companies, greater than 50% fail after 5 years, and greater than 70S% fail after 10 years
Relators
People who discover a false claim
Direct access laws
Permit the provision of occupational therapy services without a physician or other qualified provider's prescription or referral
Medicare abuse
Practices that, either directly or indirectly, result in unnecessary costs to the Medicare program. It is not possible to establish if the acts were committed knowingly, willingly, and intentionally.
Indemnity costs
Primarily provide financial support to cover wages lost by a worker who has sustained an injury
Professional liability
Professional liability = professional services + responsibility + accountability
Stark Law
Prohibits physicians from referring Medicare patients for certain "designated health services" to an entity with which the physician (or an immediate family member) has a financial relationship, unless an exception applies
Family and Medical Leave Act
Protects job security for employee leave
Vocational rehabilitation
Provide support for people with disabilities through a comprehensive regime of services meant to maximize their ability to participate in productive activities
Permanent total disability (PTD)
Provided in extreme cases where impairments from an injury restrict an individual's ability to return to work of any sort
Anti-Kickback Statute (AKS)
Purpose of this is to limit the influence of financial incentives on health care. Specifically prohibits kickbacks by making it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal health care program.
Permanent partial disability
Received when an individual reaches maximum medical improvement (MMI) and impairments in function persist that reduce the ability to perform job tasks at a previous level
Gainful employment
Refers to a situation in which individuals are able to maintain continuous participation and successful performance of job duties, realizing benefits through financial or other positive rewards
Third party payers
Refers to the insurance company or other entity that is paying for services (patient is the first party, provider is second)
Improper retention of overpayments
Requires overpaid providers to report overpayments and return them within 60 days of identification. On the 61st day the retained overpayment becomes a false claim, even if the original error that resulted in overpayment was an innocent mistake.
Secretary of labor
Responsible for administration of OSHA including development and implementation of occupational safety and health standards
Basic budget
Revenue - expenses (total overhead) = profits
Goals are based on
SWOT analysis, mission, and vision
Medical necessity
Services are medically necessary if the documentation indicates that they meet the requirements for medical necessity including that they are skilled, rehabilitative services, provided by clinicians (or qualified professionals when appropriate) with the approval of a physician/NPP (nonphysician practitioner), safe, and effective
Strategic plan
Sets the pathway for an organization's development and success
Medical reviewer
Someone hired by an insurance company to review documentation and determine whether the services are covered by the insurance policy
Vision
States an ideal of what the organization perceives as its desired and prized benchmark of achievement
No-fault workers' compensation
System guarantees payment for medical expenses for a work related injury or illness without either the employer or the employee being identified to have been at fault.
Essential functions
The activities and tasks that constitute the reason a particular job exists and are the components of a job an employee must be able to perform with or without reasonable accommodation to maintain employment
Temporary total disability
The most common wage loss benefit, is paid to an employee who must take time away from work while initially recovering from a workplace injury.
Documentation
The official written record that details or summarizes the provision of occupational therapy services
Mission
The stated purpose of an organization that provides the foundation for its very existence and plans
Harassment
Unwelcome behavior baed on race, color, religion, sex, pregnancy, national origin, age (40 years or older), or genetic information
ICD-10 codes
Used in health care to identify specific diagnoses for clients served
G-codes
Used on claims forms to identify the type of provider
Upcoding
When OT practitioners, facilities, or practices Bill for interventions with billing codes that reimburse at a higher amounts instead of billing codes for the services that were actually provided, which reimburse at a lower rate
Self-identified overpayment
When a provider through the exercise of reasonable diligence, determines that they received an overpayment and quantified the amount of the overpayment. The provider must pay back the overpayment within 60 days
Unbundling
When health care practitioners, facilities, and practices bill for codes separately instead of using a predetermined group, or "bundled code"
Mission statement answers-
Why does the clinic exist? What function does it perform? For who does the clinic perform this function or who are the primary beneficiaries? How does the clinic go about filling this function?
Organizational ethics
a common sense of purpose and values within an organization that includes culture, trust, processes, outcomes, and character - conveyed through mission statements, policies, and practices - sometimes there is a disconnect
Independent contractor financial consideration
a contractor must track expenses and understand how to write off expenses
Defamation
a false statement that the employer tells another individual about an employee and the statement results in harms to the employee
Qualifications
a listing of required and preferred education, experience, and credentials required for the job
Entrepreneurship
activities associated with participation in the creation of a business structure that has a goal of taking a new idea to market, usually for a profit
Abuse
acts not able to be proven committed knowingly, willfully, or intentionally, which fraud is
Marketing examples
advertising, sales promotions, public relations, personal setting
Target marketing
allows you to reach, create awareness in, and ultimately influence the group of people most likely to select your products and services as a solution to their needs
Vicarious liability
an employer or supervisor can be found liable for the harm caused by their employees and subordinates - supervisors must be able to demonstrate/document that they took reasonable steps to prevent inappropriate conduct
Budget
an itemized summary of estimated or planned expenditures for a set time period
Duty of loyalty
an obligation of the employee not to steal or disclose the employer's confidential or proprietary information (secret formulas, processes, and methods used in production) - often employers will have employees sign and other agreements such as a non-compete
How often should policies and procedures be reviewed?
annually
Negligent supervision
another basis for malpractice when superior is held liable for actions of others that were not their fault for incompetence; meaning employees were inadequately trained or supervised
Independent contractor
autonomous service provider who delivers therapy for a predetermined contractual rate - these individuals control their own hours, liability, and expenses
How do managers calculate revenue?
based on payer reimbursement history per unit of service provided and average number of patient visits per week/day/month
Job title
brief 2-3 word phrase characterizing the job
Local laws (case laws)
can affect federal laws and regulations
Ethical dilemmas
can arise as managers seek to balance the business priorities and the needs of staff and their patients
Bundled codes
certain codes that are billed as a group rather than individually
Legal claims fall into 2 main categories:
civil and criminal claims
Client satisfactions is related to:
client-provider relationship client inclusion in treatment plan communication physical environment
Managers must support both -
clinical needs of clients and appropriate clinical decision making by staff while ensuring profit
Practice guidelines
clinical practical guidelines - systematic review of evidence
Space analysis considerations
clinical space per therapist how many clients seen appropriate privacy appropriate space for equipment accessibility - entrance/parking other factors - flooring, lighting, line of sight, restrooms, break rooms, storage, waiting area
Composite
combines multiple measures for a comprehensive evaluation of overall care
Cons of W-2 employee:
company determines work hours dress code equipment use overall policy and procedures
Compensatory damages
compensate injured party with monetary relieve
Independent contractor and IRS control
contractor's rate is usually higher than a salaried position, but contractor is responsible for all scheduling, taxes, expenses, and time management
HEAT - Healthcare Fraud Prevention Enforcement Action Team
coordinated efforts by DOJ, HHS, OIG to fight fraud
Fixed costs
costs that do not change over a period of time - rent, salaries, benefits
Variable costs
costs that vary directly with output (changes with the volume of services provided) - can be medical supplies, office supplies, utilities, repair and maintenance, and advertising
Manager's role in billing
create policies about how to bill and what to bill for to ensure accurate billing procedures and teaching staff how to submit daily billings
Strategic planning
creates the means for an organization to both examine its current position and chart a future course, anchored by mission and vision, and based on SWOT analysis
Essential functions
critical for physical, cognitive, or emotional abilities that are required for job performance
Fraud
defined as making false statements or representations of material facts to obtain some benefit of payment - knowingly, willfully, and intentionally
Quality
defined as the degree to which health care services increases the likelihood of desired health outcomes
Scope of practice
defined by the licensure regulations of the state where services are provided - managers need to be sure that job descriptions, policies, and procedures fit within
Market position
defining an organizations unique proposition (how its service is different/special)
How to manage risk
demonstrate a proactive commitment to best practice and safety
Outcome measures
determine the impact of the care provided on the client's overall health and wellness
Regulations
developed by federal and state agencies examples include CMS and state health departments
Contract
document that governs the relationship between parties, usually generated by the organization or contractor
Job descriptions
document that serves to shape employee roles and helps managers with recruitment, orientation, and staff development
75% productivity example
each FTE is expected to spend 6 hours of an 8 hour day performing billable activities sometimes called benchmarks
Employee right to privacy
employees have a limited right to privacy in the workplace
Social media
employees may restrict employee access to social media during working hours but cannot control after hours - some states have enacted lifestyle discrimination statutes that forbid employer restrictions on employees' behavior off duty and off employer's premises
Who pays professional liability insurance?
employer (often times)
GINA & employer
employer is permitted to request genetic information for limited exceptions such as providing a wellness program; however, employer must keep info confidential
Employer liability
employers can be directly liable for their actions and indirectly liable for actions of employees
NLRB - National Labor Regulations Board
enforces employee's right to organize and use unions as their bargaining representative
Intrapreneur
entrepreneur who starts an innovative process within a larger organization that brings new products and programs to market
Deductible
established amount that a client must pay before the insurance begins covering services
Vision statement
expresses the aspirational and inspirational messages about what a department of organization would like to become as it seeks to begin its mission
Negligence
failure to exercise the standards of a reasonable, prudent person would exercise in a similar situation; involves careless action or an unintentional mistake example: not placing a wet floor sign on a recently washed floor
Most common injuries sustained in OT
falls, burns, and equipment injuries
Business plan includes:
finances partners timelines costs and profit customers price points
Documentation
first place a legal team will investigate when claims are filed against OT, so we must write with the expectation that it will undergo a detailed critique
Copays
flat fee for service that beneficiaries must pay per visit
Process measures
focus on delivery of care and the adherence to best practice treatment protocols
Exempt employee
generally paid a salary, so not eligible for overtime pay 3 categories: executive, professional, and administrative
COPM
gold standard for evaluating client-centered, occupation-based, and evidence-based OT services throughout the continuum of care in a variety of settings
Employers can't:
hack into employees person emails or search bags, purses, or vehicles
Direct medical expenses
hospitalization, physician visits, diagnostic tests, surgical procedures, rehabilitative interventions, and prescription drug costs
Productivity
how many units of work employees are expected to produce in a given time period
Proforma
hypothetical balance sheet and income statement based on a set of assumptions
First step in strategic planning
identifying the purpose of the organization
Privacy
implies the right of patients to be left alone and free from intrusion, and to choose whether or not to share oneself
Malpractice
improper or unethical conduct or unreasonable lack of skill by a holder of a professional or official position; often applied to physicians, dentists, lawyers, and public officers to denote negligent or unskillful performance of duties when professional skills are obligatory
Compliance
in order to ensure this, managers must be knowledgeable with relevant laws, regulations, and payer policies
Policies and procedures manual
include step by step instructions and information about official department and institutional policies
Payers
includes individuals, insurance carriers, employers, and the government
Corporate overhead
includes the administrative aspects of a business, such as HR, billing services, and the executive administration
Reporting relationships
indicate whom the person in the job reports to as well as who is responsible for supervising
Entrepreneur
individual who sells a product or service in the hope of a profit but often at considerable risk
Tort law
intentional or negligent harm or wrong against another that results in damages for which one party may be liable
Quality benchmarking
involves voluntary, active collaboration targeting use of optimally efficient indicators, practices, and costs
Why would a company want to hire contractors?
less costly for the company overall because company does not have to pay payroll taxes, health benefits, training, workers comp, overtime, or supplies
Organizational chart
management tool that visually depicts the following aspects: major functions relationships of functions or departments channels of supervision lines of authority and communication position by job title
negligent hiring
managers are expected to do background checks on future employees to avoid this, which is important when employees are responsible for the care of others
FCRA - Fair Credit Reporting Act
mandates accuracy, fairness, and privacy of the files of consumer reporting agencies - if an employer decides to fire or not fire a person due to a credit report, the employer must provide individual with a copy of the report and employee can dispute this
Monitoring
marketing plans must undergo periodic reevaluations to assess effectiveness; should be a process that analyzes all aspects of the client's marketing journey
Disclosure
means giving another party access to a pt.'s protected health information without permission; can result in drastic consequences for patients
Calculating square footage
measure the length x width of the room
Employers can:
monitor use of company's mail or email as long as employee is notified, search company lockers and desks, collect confidential info, but must protect info
Managers and the environment
must be sure environment is safe and uncluttered and equipment is working and maintained to avoid falls and other injuries
Standardized measures
must be used to make accurate comparisons between providers (COPM, DASH, FIM/GG, KELS, WRI, etc)
Assault
occurs as a threat that another will engage in an offensive touch or cause them immediate harm
Battery
occurs when a person intentionally comes in physical contact with another person
Intentional infliction of emotional distress
occurs when through extreme and outrageous conduct, someone intentionally causes severe emotional or mental distress - example: OT cursed and screamed at client with depression for showing up late and insisted they leave
Performance improvement collectives
often institutions join performance improvement collectives to have access to pooled-data analytics, strategic research, and advocacy resources
Vision statements
often lay out the most important primary goals but does not outline a plan to achieve goals
Capital expenses
often not included in yearly budget and have a minimum dollar amount with detailed justification (equipment, how/why it is used, etc.) - ranges from $2500 - $10000
Overhead
operating expenses of a business, including costs of rent, utilities, salaries/labor, interior equipment, taxes, supplies, materials, etc
External aspects of SWOT analysis
opportunities and threats
Benefits may include:
paid vacations, sick leave, health insurance, holidays, liability insurance, continuing education, and disability insurance
Employment law
plays an important role protecting worker safety, prohibiting discrimination, and preserving employee and employer rights
Administrative directives
policies or mandates from management affecting patient care that may override clinical judgment
Consensus statements
practice recommendations developed by experts to make recommendations for treatment interventions
Pros of being W-2 employee:
predictable paycheck taxes withheld from every paycheck employer shares in tax responsibilities benefits
Risk
probability of threat or damage, injury, liability, loss, or any other negative occurrence that is caused by external or internal vulnerabilities, and that my be avoided through preemptive action
Assault and battery in healthcare typically occur when:
procedures are performed without informed consent (a rational informed decision about a particular treatment or procedure)
Marketing research
process of gathering, analyzing, and interpreting information about a market; about a product or service to be offered for sale in the market; and about past, present, and potential customers
7 P's of marketing
product, price, place, promotion, people, process, and physical evidence
GINA - Genetic Information Nondiscrimination Act
prohibits employers from requesting, requiring, or purchasing genetic information about applicants or employees
Professional liability insurance
protects the policyholder by providing legal defense resources, as well as paying claims and compensatory judgments (damages) typically about $100/year
Modifiers
provide specific information that permits payment of services
Marketing plan
provides a framework for creating goals and specific marketing strategies to support growth of business
Punitive damages
punishment of the party who caused the harm
Implementation
putting the marketing plan into action
Patient experience measures
records a patient's perspectives on the care they received
Confidentiality
refers to information or data about the patient that OTs have an obligation to preserve by OT Code of Ethics and HIPPA law
Marketing mix
refers to the tactical, controllable, and operational components of a marketing plan
EEOC - Equal Opportunity Employment Commission
responsible for enforcing laws making it illegal to discriminate against job applicants or employees based on race, color, religion, sex, national origin disability, or genetic information
DOL - Department of Labor
safeguards employees wages, working conditions, opportunities for advancement, and work related benefits
ICHOM (international consortium for health outcomes measurement)
seeks to transform health care systems worldwide by measuring and reporting patient outcomes in a standardized way also provides condition-specific standard sets of outcome measures
COPM as an outcome measure
semi-structured interview format structured scoring method designed to detect perceived changes over time valid and reliable
HIPAA - Health Insurance Portability & Accountability Act
sets standards for protecting PHI
Mission statement
setting forth a department's purpose, including definitions, products, or services
Structural measures
setting, physical environment, number of personnel, availability of specialists, and staff-to-client ratios
Employer liability responsibilities
should verify OT state license, background check, searching US Dept of Health & Human Services
Termination
sometimes called "lay off" employers generally have the right to terminate employees or a variety of reasons
Target market
specific group of consumers or clients at whom a company aims its products and services - clients/potential clients, payers, referral sources
Typical start up costs
staff (salaries and benefits) space/rent utilities equipment/supplies administrative supplies corporate overhead marketing training
Regulatory law is created by
state or federal agencies
Characteristics of an entrepreneur
strength in specific skills knowledge perseverance ability to develop positive relationship creative problem solving and critical thinking leadership abilities experience working with effective teams adaptability in an ever-changing environment dedication, confidence, and fortitude goal-minded receptive to new idea/change networking
Internal aspects of SWOT analysis
strengths and weaknesses
Recommended ways to measure quality
structural process outcome patient experience measures composite
Needs assessment
systematic approach used to identify gaps between current practices and desired practice conditions to determine a course of action
Cost of doing business
take all expenses (overhead) for the year and break it down to monthly, daily, and housefly expenses to get an idea of what it takes to break even
Marketing
the art and science of exploring, creating, and delivering value to satisfy the needs of a target market at a profit
Qualified privilege
the employer may communicate employee information if it serves a legitimate business purpose and the employer believes it to be true
Social entrepreneur
the entrepreneur of a nonprofit organization where the focus is on social equality rather than financial profit
Location
the facilities in which a program is housed are often a key factor in whether or not a program is successful
Program evaluation
the ongoing process of assessing the impact and quality of program process and outcomes and making the continuous improvements in efficiency and effectiveness
Program planning
the process of identifying the steps and sequence of action to be taken to plan for initiation of the program
Program implementation
the process of initiating intervention; typically in trial format and then in a more formal and sustained manner
Keys to becoming a successful contractor:
time management organization understanding of expectations of prospective employers how to market services cash flow management
Non-billable time
time spent in family conference, interdisciplinary meetings, discussing a case with MD, documentation, on the phone ordering equipment, marketing, looking up evidence, etc
Most lawsuits filed against OTs fall under this law
tort law
Malpractice
type of negligence that can occur when a practitioner fails to follow the standard of care and the failure results in harm or injury to a client; practitioner is aware of actions and proceeds anyway - can result in compensatory damages or punitive damages
Market analysis
use of assessment techniques to understand customers, markets, and marketing effective: then the information is used to generate a plan
Quality measurement
using data to measure the performance of the health care provided
Managers have a responsibility to create a workplace culture based on:
values of integrity, accountability, fairness, and respect
Changes are often in the form of a:
vision or vision statement
Break even
when costs are equal to money brought in for services, leaving no debt and no profit
Moral distress
when one knows the right thing to do but encounters a barrier preventing action
False imprisonment
when someone violates another's basic personal right to freedom from wrongful confinement - in healthcare, this could be from restraining patients in a SNF without documented plan for safety
Professional isolation
with new areas of entrepreneurship, there may not be many others doing similar activities; helpful to connect with professional organization, blogs, academia, and online groups
Federal law requires that employers provide the following benefits:
worker's compensation time off for jury duty or military service tax withholding & FICA state & fed unemployment tax compliance with FMLA
W-2 consideration
workers who are not independent contractors have W-2 employment status
